It isn’t often that a book that sets out a case that drugs were used to disorient and disable Guantanamo detainees for interrogation makes the front pages, or gets the news coverage one new book did. What’s even more remarkable is that the revelations in that book are just the tip of the iceberg, as new evidence shows the drug use was even greater and more varied than previously reported.

Earlier this year, Simon and Shuster published to great acclaim former Guantanamo guard Joe Hickman’s book, Murder at Camp Delta: A Staff Sergeant’s Pursuit of the Truth About Guantanamo Bay. The book described Hickman’s investigation of the 2006 purported suicides by three Guantanamo inmates, deaths the Guantanamo commander, Rear Adm. Harry B. Harris Jr., called at the time, “asymmetrical warfare waged against us.”

But rather than a planned terrorist event of exquisitely-timed suicidal protest — an implausible tale in the high-security Guantanamo setting to begin with — Hickman, whose story was first told in an award-winning Harper’s magazine article in 2010, discovered the deaths were likely linked to a secret, most likely CIA, black site on the Guantanamo base. As a tower guard, the night of the “suicides” he had witnessed three detainees secretly taken out of camp earlier that evening and driven in the direction of the black site.

Later, he was witness when the warden at the Guantanamo prison facility, Army Colonel Michael Bumgarner, told prison personnel that despite the fact it was known in the camp that the prisoners had died with rags stuffed down their throats, they were to say nothing to the press when the story was released the detainees supposedly had hanged themselves. A year after the Harper’s article, Almerindo Ojeda, a researcher at University of California, Davis, made a strong case that the three detainees had been killed by a torture technique known as “dryboarding.”

Hickman knew the official story did not hold together, and while he tried to put the nightmare of Guantanamo out of his mind, when a year later another detainee died of supposed suicide, Hickman knew he could not let the story rest. He began a private investigation into what occurred, later linking up with researchers led by attorney Mark Denbeaux at Seton Hall University Law School’s Center for Policy and Research. Together, they released a number of reports deconstructing and refuting the official story.

The most recent Seton Hall report, published last year, included claims Hickman would make in Murder at Camp Delta, including charges that the Naval Criminal Investigative Service (NCIS) had suppressed evidence from their report, removed witness statements, failed to interview other crucial witnesses, and in general had produced, at best, a shoddy work. At worst, it was circumstantial evidence of a major government cover-up.

But one of the strangest links in the tale of government crimes concerned the use of a drug meant to prevent or help cure malaria. As Hickman was looking over a deceased detainee’s medical record, he discovered that the detainee had been give a large dose of mefloquine upon admission to Guantanamo. (Mefloquine is often known by its former brand name, Lariam.) He later found that mefloquine had been administered to all the Guantanamo detainees on medical intake. But what was mefloquine?

Why Mefloquine?

Mefloquine administration was standard operating procedure upon admission. The official story, first reported to Jason Leopold and me and published at Truthout, was that Cuban officials told Guantanamo camp officials that they were worried that detainees would bring malaria to the otherwise malaria-free Cuban isle. Perhaps never in the annals of U.S. history were Department of Defense officials so sensitive to Cuban fears and needs.

According to Navy nurse, and then chief surgeon for Guantanamo’s Task Force 160, Capt. Albert Shimkus, at the behest of the Cubans he gathered experts, and a determination was made that mefloquine would be the primary drug used to control possible malaria. But when queried more closely on the issue, including the fact Cuba had no malaria, Shimkus admitted he and others had been told there were “certain issues we were advised not to talk about.”

But to date, Shimkus’s story, which supposedly included consultation with the Centers for Disease Control (CDC), the Navy Environmental Health Center (NEHC) and the Armed Forces Medical Intelligence Center at Fort Detrick, Maryland, has not panned out, as FOIA requests for documents from the above agencies have all received a response of “no responsive documents.”

Even more, as another article I wrote in 2011 with Leopold explained, foreign workers brought in to build Camp Delta itself were drawn heavily from malarial-endemic parts of the globe, including India and the Philippines, but DoD showed no interest in ensuring these workers did not carry malaria.

What DoD did was administer 1250mg of mefloquine in divided doses in the first 12 hours. Hickman is correct that this is five times the usual prophylactic weekly dose of the drug. But it is not, as Hickman portrays it in the book, a “massive overdose” of the drug. It is the amount administered when you are seeking to eliminate a certain stage of the malaria parasite from the bloodstream. It is a “treatment dose.”

But that does not change the fact, which Hickman discovered, that there was no reason to administer such a large dose, and that large doses of the drug — even the lower 250 mg level prophylactic dose — carried intolerable neurological and psychological side effects.

Indeed, by 2013, DoD had requested that all service personnel, including special forces, forego use of the drug because of rare but documented neurological toxicity. That same year, the prestigious Institute on Medicine as a Profession called for an investigation on the use of mefloquine at Guantanamo.

An Army doctor-researcher, Remington Nevin, later confirmed in a 2012 published report in the medical journal Tropical Medicine and International Health that DoD’s “presumptive treatment” of possible mefloquine in the detainees was both unprecedented and “inappropriate.” He added that his “analysis suggests the troubling possibility that the use of mefloquine at Guantanamo may have been motivated in part by knowledge of the drug’s adverse effects….”

Hickman would conclude that the mefloquine was used at the highest known dosage precisely because of its propensity to cause side effects, including dizziness, nightmares, nausea, and suicidal feelings.

“… [T]he entire purpose of Gitmo,” Hickman wrote, “was to practice new interrogation techniques on detainees, regardless of any information they may or may not have possessed. From this research, it became clear that not only was mefloquine administered as part of this program, the deaths of the three detainees likely occurred under the shadowy operations of something called a special access program (SAP)— and it had to be kept secret at all costs.”

Presence of Mefloquine Examined in Autopsies

But there was more to the drug story than even Hickman knew. According to autopsy records for one of the three 2006 “suicides,” Yemeni prisoner Ali Abdullah Ahmed, and the May 2007 death that had galvanized Hickman’s investigation, the purported suicide of Abdul Rahman Al Amri, both had autopsy reports that specifically called for toxicology results on the presence of possible mefloquine in their bodies. See here and here.

But this made no sense. Why would Armed Forces epidemiology workers look for mefloquine in some of the deceased detainees and not others? Why would they look for mefloquine at all, as it was supposedly only administered as a malaria precaution upon entrance to the facility? Both Ahmed and Al Amri had been at Guantanamo four years or more when they died. Neither of their medical records such as we have extant point to the presumed presence or fear of infection by malaria.

The evidence points to use of the drug for other than malaria prophylaxis or treatment, in other words, exactly for the use that Hickman and Nevin and the Seton Hall researchers feared. The drug was being used to torture people.

Other Drugs Used: Chloroquine

But there was even more.

Al Amri, like the three 2006 detainees, was discovered with his hands bound. But unlike the 2006 victims, Al Amri had his hands tied behind his back.

As for Yasir al Zahrani, Mari Al-Utaybi, and Ahmed, the three 2006 “suicides,” all had been tested for the presence of yet another antimalaria drug, chloroquine. (Of the three, only Ahmed was tested for presence of mefloquine.)

Chloroquine has long been used in the prophylaxis and cures of certain forms of malaria. Over the years mosquitos in various parts of the world have become immune to chloroquine. Nevertheless, it remains a drug in common usage, though it has its own problematic side effect profile. While not as neurotoxic as mefloquine, chloroquine can cause a large range of side effects, including dizziness, blurred vision and “extrapyramidal disorders (eg, dystonia, dyskinesia, tongue protrusion, torticollis).”

Chronic or long-term use of the drug can cause even worse side effects, including muscle weakness. There are a host of other “rare” side effects.

While other drugs involved in the toxicology tests on the three detainees, including for the presence of “cannabinoids” and cocaine, could be chalked up to the use of a standard protocol, there’s no reason to assume that chloroquine, a drug used almost exclusively for malaria, should have been on the standard drug testing test panel. Indeed, the fact that mefloquine was included for testing on one of the three detainees demonstrates that the drug test could be manipulated selectively.

Was chloroquine also used as a drug of disorientation and abuse on detainees? We don’t know for sure. In his book, Hickman pointed to a 1977 Senate investigation that disclosed past CIA research on the class of drugs from which mefloquine was derived. (Hickman wrongly attributes the entire investigation to use of that class of drugs, but it was a much larger investigation than that.)

Hickman’s nod in that direction got me looking a few years ago, and I discovered that not only had the CIA investigated that class of drugs, but they used at least one of these drugs, a cousin of mefloquine called Cinchonine, as an “incapacitating drug” in its MKULTRA program. The revelations were part of the famous 1975 Church investigations in the U.S. Senate.

Not only were there indications that the antimalaria drugs mefloquine and chloroquine were used to chemically degrade the physical and mental condition of prisoners, but now there was a CIA precedent!

Other Drugs Used: Scopolamine

If the malaria drugs were used to incapacitate and disable, I asked myself, were there any other drugs used for the same purpose? We knew from a DoD Inspector General report that antidepressant and antipsychotic drugs were administered to detainees before interrogations (though DoD maintains not supposedly to affect the interrogation), even forcibly to restrain prisoners. But was there anything else like the antimalaria drugs?

Yes, there was. I discovered that the Standard Operating Protocol for nurses dated October 2003 refers to the presence of a scopolamine patch behind the ear on incoming detainees, themselves flown via extraordinary rendition to Guantanamo. (We now know some of those renditions were funneled via DoD’s European command out of Germany.)

Scopolamine has a long history as a supposed “truth drug.” While it is sometimes prescribed to prevent air sickness — and that’s the official reason DoD used the drug on detainees — it is also known to cause a number of disorienting side effects. In fact, as far back as 1956, the military advised using meclizine instead of scopolamine to deal with motion sickness in pilots because of the latter’s “distressing side effects.”

The side effects, according to a CIA document that detailed use of the drug for possible interrogation, include “hallucinations, disturbed perception, somnolence, and physiological phenomena such as headache, rapid heart, and blurred vision.”

Scopolamine has long-lasting effects. We can see now that prisoners arrived in Guantanamo frightened and disoriented. They had often been hooded. All were retrained. Many must have been suffering side effects from the scopolamine. Upon arrival they were given mefloquine, another long-lasting drug with possible horrific side effects. And these are only the drugs we know about. None of these drugs were either first-rank drugs, and in the case of mefloquine and chloroquine, there was no known reason to presumptively give the drug upon arrival. And even if there were, there was even less reason to administer the drug again years after a prisoner’s initial medical intake at the island prison.

We owe a huge debt of gratitude to Joe Hickman for digging out much of this information, and having the courage to publish it and talk publicly about it. But as Hickman writes at the end of his book, “I wrote this account to provoke further research and informed debate, so that hopefully we may do a better job with our detention program.”

I think that detention program is an abomination. It was and likely remains an experimental program in interrogation and torture. It should be closed down, and a full independent investigation with subpoena powers undertaken to finally bring the criminals who implemented the torture to justice.

While Hickman’s book has gotten great coverage in the press, no one has really picked up the author’s challenge to further the research the book began. This review is offered as a challenge itself to extend the investigative reporting on Guantanamo and the U.S. torture detention program in general.

The recent publication of the Senate Intelligence Committee’s report on the CIA torture program was a limited hangout, and questions about the origin of the program, or how exactly it was approved and implemented still remain unknown. The Senate will not release the vast bulk of their own study for public consumption. Indeed, they will not even explain inconsistencies in their own account, such as the presence of SSCI staff members at the CIA’s Dark Prison black site in Afghanistan in late 2003.

The truth is that only a public outcry will bring significant attention to move the torture story beyond the partial boundaries set by human rights organization attorneys, vote-sensitive politicians, and career-fearing journalists. Hickman has shown that the examination of drugs in the U.S. torture program can be mainstream. Who will pick up the baton now?

Jeff Kaye

Jeff Kaye

Jeffrey Kaye is a retired psychologist who has worked professionally with torture victims and asylum applicants. Active in the anti-torture movement since 2006, he has his own blog, Invictus, previously wrote regularly for Firedoglake’s The Dissenter, as well as at The Guardian, Truthout, Alternet, and The Public Record. He is the author of Cover-Up at Guantanamo, a new book examining declassified files on treatment of prisoners at the Guantanamo detention camp.